580394

research-article2015

JADXXX10.1177/1087054715580394Journal of Attention DisordersGoulardins et al.

Article

The Relationship Between Motor Skills, Social Problems, and ADHD Symptomatology: Does It Vary According to Parent and Teacher Report?

Journal of Attention Disorders 1­–10 © 2015 SAGE Publications Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1087054715580394 jad.sagepub.com

Juliana B. Goulardins1, Daniela Rigoli2, Pek Ru Loh3, Robert Kane2, Melissa Licari4, Beth Hands5, Jorge A. Oliveira1, and Jan Piek2

Abstract Objective: This study investigated the relationship between motor performance; attentional, hyperactive, and impulsive symptoms; and social problems. Correlations between parents’ versus teachers’ ratings of social problems and ADHD symptomatology were also examined. Method: A total of 129 children aged 9 to 12 years were included. ADHD symptoms and social problems were identified based on Conners’ Rating Scales–Revised: L, and the McCarron Assessment of Neuromuscular Development was used to assess motor skills. Results: After controlling for ADHD symptomatology, motor skills remained a significant predictor of social problems in the teacher model but not in the parent model. After controlling for motor skills, inattentive (not hyperactive-impulsive) symptoms were a significant predictor of social problems in the parent model, whereas hyperactive-impulsive (not inattentive) symptoms were a significant predictor of social problems in the teacher model. Conclusion: The findings suggested that intervention strategies should consider the interaction between symptoms and environmental contexts. (J. of Att. Dis. XXXX; XX(X) XX-XX) Keywords ADHD, social skills, motor performance

Introduction During childhood, movement experiences are crucial for providing learning opportunities and promoting the development of important daily skills, such as using cutlery, drawing, and playing games. The recognition of the importance of motor competence for social and emotional development is now also increasing given the numerous studies showing a significant link between these domains (Cummins, Piek, & Dyck, 2005; Piek, Bradbury, & Elsley, 2008; Rigoli, Piek, & Kane, 2012; Skinner & Piek, 2001). Furthermore, psychosocial problems are hypothesized to be secondary consequences to motor problems (Cairney, Rigoli, & Piek, 2013) and tend to appear once a child is challenged by social and peer demands in the school years (Piek et al., 2008). This is partly supported by longitudinal studies showing that motor skill difficulties earlier in childhood are related to later psychosocial problems (Lingam et al., 2012; Losse et al., 1991). The relationship between the motor and psychosocial domains may be partly explained by the fact that in many countries, the ability to perform well in sports and games is highly valued (e.g., Vannattaa, Gartsteinb, Zellerc, & Nolld,

2009). Participation in such activities also promotes the development of supportive interpersonal relationships and social ties in children (McHale, Crouter, & Tucker, 2001). This creates a problem for those who experience difficulties with movement skills. Research has shown that children with motor problems are less likely to participate in organized (e.g., sport teams) and unorganized (free play) activities (Cairney et al., 2005). Other studies have revealed greater self-reported loneliness in boys with motor problems compared with their coordinated peers; furthermore, team sports participation was found to significantly mediate the inverse relationship between loneliness and physical coordination 1

University of Sao Paulo, Brazil Curtin University, Western Australia, Australia 3 James Cook University, Singapore 4 University of Western Australia, Australia 5 University of Notre Dame, Western Australia, Australia 2

Corresponding Author: Juliana B. Goulardins, Laboratory of Motor Behavior, School of Physical Education and Sport, University of Sao Paulo (USP), Av. Prof. Melo Morais, 65, Cidade Universitaria, Sao Paulo, 05508-030, Brazil. Email: [email protected]

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

2

Journal of Attention Disorders 

(Poulsen, Ziviani, Cuskelly, & Smith, 2007). Skinner and Piek (2001) highlighted how children with motor difficulties often try to avoid participation in such activities for fear of failure and/or peer criticism. By avoiding participation, children then limit their opportunity to practice skills and to participate in a social environment, thereby creating a vicious circle. Studies investigating the relationship between motor difficulties and the social domain have revealed that children with movement problems have self-reported fewer playmates and are asked to play with other children less often (Boyer, Geurts, & Van der Oord, 2014). They also spend more time alone or watching other children play without participating themselves (Smyth & Anderson, 2000). Livesey, Lum Mow, Toshack, and Zheng (2011) found that these children receive lower scores on a measure of peer preferences in play settings when rated by their peers. According to teacher-report, they also experience greater peer exclusion (e.g., more likely to be ignored and ridiculed by peers; Livesey et al., 2011). Problems in the social domain for children with motor difficulties have also been reported by parents (Cummins et al., 2005). Other research has also found a relationship between peer-victimization and movement problems in children (Campbell, Missiuna, & Vaillancourt, 2012; Losse et al., 1991). Furthermore, it appears that children with motor problems are aware of these difficulties as they have reported lower levels of perceived social acceptance and support (e.g., Boyer et al., 2014; Skinner & Piek, 2001). Most of these studies have been carried out with primary school aged children (i.e., 6-12 years old); however, it has also been suggested that the relative importance of social support and acceptance may increase from childhood to adolescence (Skinner & Piek, 2001). For example, Skinner and Piek (2001) found a significant difference in perceived social acceptance between adolescents with and without motor coordination difficulties but not for younger children. Accumulating evidence for an important link between the motor and social domains is concerning given that social support may act as an important buffer, protecting against possible internalizing problems for children with motor difficulties (Cairney et al., 2013). Furthermore, in addition to interpersonal difficulties, children with motor difficulties have an increased risk of social difficulties, including nonverbal facial emotion cues (Cummins et al., 2005). Importantly, in a recent article, social skills were found to mediate the relationship between motor skills and internalizing problems in young pre-primary children (Wilson, Piek, & Kane, 2013). Therefore, further research examining the relationship between these areas is needed, particularly as social competence may mediate the relationship between motor and internalizing problems. Although accumulating evidence now suggests that motor problems are significantly related to social difficulties, many

previous studies have not accounted for the role of ADHD symptomatology in this relationship (Pettersson et al., 2015; Skinner & Piek, 2001). This is important given the strong overlap between motor difficulties and ADHD, which has been recognized for decades and estimated to be around 50% (Fliers et al., 2008; Pitcher, Piek, & Hay, 2003). In addition, there are numerous studies linking ADHD symptoms with problems in social functioning (Frederick & Olmi, 1994; Marques et al., 2013; Nijmeijer et al., 2008; Schlack, Mauz, Hebebrand, & Holling, 2014; Wehmeier, Schacht, & Barkley, 2010). In fact, some of the behaviors that are related to the social problems evident in children with ADHD are listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) ADHD criteria, for example, “often interrupts or intrudes on others” (i.e., impulsivity), “often talks excessively” (hyperactivity), and “often does not seem to listen when spoken to directly” (i.e., inattention; APA, 2013). It is widely acknowledged that children with ADHD symptoms are at increased risk of peer relationship difficulties, such as peer rejection, compared with typically developing children without these symptoms (Tseng, Henderson, Chow, & Yao, 2004). Hoza et al. (2005) found that children with ADHD scored lower on social preference and higher on social impact, were less well-liked, and had fewer dyadic friendships. It has also been suggested that ADHD symptomatology may have differential impacts on social outcomes (Tseng et al., 2004), for example, social dysfunction seen in those individuals with hyperactive/ impulsive symptoms may be characterized by disruptive and aggressive behaviors, ultimately leading to interpersonal difficulties such as peer rejection. Conversely, social difficulties in inattentive children may be characterized by more passive behaviors, including shyness, anxiety, and withdrawal (Schlack et al., 2014). Children with attention difficulties may also be less likely to attend to social cues and implicit rules for social interactions (Bierman, Smoot, & Aumiller, 1993). Although ADHD symptomatology may predispose children to social problems, it is not clear whether social dysfunction is inherent to ADHD or is mediated by the existence of co-occurring difficulties, such as motor problems. Limited research has taken this into account, however, some studies have shown that ADHD with motor problems is linked to greater social problems when compared with ADHD-only, according to both parent and teacher observations (e.g., Tervo, Azuma, Fogas, & Fiechtner, 2002). A recent study investigated the relationship between motor coordination and social problems in individuals with ADHD and found a significant inverse relationship between these areas. Specifically, better motor performance was related to fewer social problems, as rated by parents (Ayaz, Ayaz, Yazgan, & Akin, 2013). Further research is needed, particularly because social competence has been highlighted as a

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

3

Goulardins et al. significant predictor for optimal developmental outcomes in both the short term and the long term (Alonso Bde et al., 2014). For example, childhood peer rejection has been shown to be one of the strongest predictors of current and future adjustment problems (Bagwell, Newcomb, & Bukowski, 1998). Furthermore, numerous studies have demonstrated an important relationship between early peer difficulties and later maladaptive outcomes, such as anxiety, depression, delinquency, dropping out of school, and substance abuse (Pedersen, Vitaro, Barker, & Borge, 2007). The present study examined whether motor performance predicts social competence in children aged 9 to 12 years, after accounting for ADHD symptomatology. Furthermore, the predictive relationship between ADHD symptomatology and social problems, after controlling for motor skills, is also examined. In addition, given the persistent deficits in social communication and social interaction associated with autism spectrum disorder (ASD; APA, 2013), and the strong association ASD has with ADHD, and motor problems (Gustafsson et al., 2014), the present study did not include any children with a previous diagnosis of ASD. Importantly, the study uses both parent- and teacherreport for social problems and ADHD symptomatology. Achenbach, McConaughy, and Howell (1987), in their meta-analysis of 119 studies, highlighted the impact of informant discrepancies (e.g., parents, children, teachers) when rating social, emotional, or behavior problems in children, a finding now replicated by many studies. For example, Wolraich et al. (2004) found a low agreement between the parent and teacher reports of ADHD symptoms (inattention, hyperactivity/impulsivity, and performance impairment) according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994)–based questionnaires. Other research has revealed non-significant cross-informant consistency between parent and teacher ratings of social competence (Fagan & Fantuzzo, 1999). In their study, Antrop, Roeyers, Oosterlaan, and Oost (2002) found a non-significant association between parent and teacher ratings of inattention and hyperactivity/impulsivity symptoms. It has been suggested that disagreement in parent and teacher ratings may be due to the different environments in which behavior is observed (Martin, Scourfield, & McGuffin, 2002). For example, parents may report higher rates of problem behaviors due to the lack of structure in the home environment compared with the highly structured school environment. Parent–teacher discrepancies may also be due to bias via contrast effects as parents may see contrast between their own children’s behaviors rather than having a variety of children to compare them to (Hartman, Rhee, Willcutt, & Pennington, 2007). For the present study, it is hypothesized that better motor performance will predict fewer social problems, after controlling for ADHD symptomatology. It is also hypothesized that motor performance will predict social competence for

both parent and teacher models. Second, it is also hypothesized that ADHD symptomatology will predict social problems, after taking motor skills into account, for both parent and teacher models. Finally, modest correlations between parent versus teacher ratings of social problems and ADHD symptoms are expected. This study examined the social problems item loadings across informants, with a focus on individual item content, which may increase the understanding of the relationship between ADHD symptoms and motor impairment.

Method Participants and Procedures A total of 129 children, 91 boys and 38 girls, aged 9 to 12 years (M = 11.2, SD = 0.8), participated in this study. Participants were recruited through schools, public advertisement via the Learning and Attentional Disorder Society (LADS), community newspapers in metropolitan Perth, and community radio. Thirty-three schools from the Perth metropolitan area participated in this study and information letters and parent consent forms were distributed to all students within the age-range for this study. Following consent, a demographic/health screening questionnaire and a replypaid envelope were sent to parents. Subsequently, the McCarron Assessment of Neuromuscular Development (MAND) was individually administered to children at school and parents and teachers were provided the Conners’ Rating Scales–Revised: L (CRS-R:L) forms to complete. Those participants recruited via advertisement were mailed out the information letter and consent forms, CRS-R: L forms, a demographic/health screening questionnaire, and a reply-paid envelope. These children were then administered the MAND individually in a quiet room at the University. All children had normal to corrected vision, normal hearing, no neurological disorder, and absence of physical disability. There was minimal evidence of birth complications in this sample, and no pre- or existing neurological or severe behavioral disorders (i.e., autism, intellectual developmental disorder, etc.). This information was obtained from the parents’ reports on the screening questionnaire. Ethics approval was obtained from the University Human Research Ethics Committee, and the ethical guidelines outlined by the National Health and Medical Research Council of Australia were followed.

Measures CRS-R:L.  The CRS-R:L (Conners, 1997), suitable for children aged 3 to 17, provides an assessment of impairment across a range of behavioral problems that is consistent with the DSM-IV criteria (Conners, 1997). The Parent (Conners’ Parental Rating Scale–Revised: L [CPRS-R:L]) and Teacher

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

4

Journal of Attention Disorders 

(Conners’ Teacher Rating Scale–Revised: L [CTRS-R:L]) versions of the long forms of CRS-R were used for this study. The CPRS-R:L (Conners, 1997) is an 80-items scale that produces T-scores for the 14 subscales of cognitive problems/inattention, oppositional behavior, hyperactivity, anxiety and shyness, perfectionism, social problems, psychosomatic behavior, Connors Global Index (comprising Restless–Impulsive and Emotional Lability), ADHD Index, and DSM-IV symptoms subscales (comprising DSM-IV Inattentive and DSM-IV Hyperactive-Impulsive). The CTRS-R:L (Conners, 1997) is a 59-items scale that produces T-scores for the same subscales as the CPRS-R:L except for psychosomatic behavior. The parent- and teacher-rated Social Problems, and DSM-IV Inattentive and HyperactiveImpulsive T-scores were used for the present study. These subscales demonstrate good internal reliability, with total reliability coefficients by gender ranging from .826 to .865 and .876 to .934 for the CPRS-R:L Social Problems and DSM Inattentive and Hyperactive-Impulsive subscales, respectively (Conners, 1997). Total reliability coefficients range from .87 to .87 and .89 and .94 for the CTRS-R:L Social Problems and DSM Inattentive and HyperactiveImpulsive subscales, respectively (Conners, 1997). MAND.  The MAND (Tarver, Daley, & Sayal, 2015) is an individually administered, norm-referenced assessment tool comprising five fine motor tasks (putting beads in a box, putting beads on a rod, finger tapping, putting a nut on a bolt, and sliding a rod) and five gross motor tasks (touching the nose and the finger of opposite extended arm, standing broad jumping, heel to toe walking, standing on one foot, and grip strength). The sum of the 10 scaled scores is converted to the Neuromuscular Developmental Index (NDI; M = 100, SD = 15), representing a measure of overall motor skills. An NDI score of 71 to 85 represents a mild disability, 55 to 70 a moderate disability, and below 55 a severe disability. Test–retest reliabilities after a month interval over the 10 tasks range from .67 to .98 (Tarver et al., 2015). The MAND also demonstrates good concurrent validity (Brantner, Piek, & Smith, 2009; Dyck, Piek, Kane, & Patrick, 2009).

Data Analysis Separate Generalized Linear Mixed Models (GLMMs) were tested for parent and teacher ratings. For each model, the dependent variable (DV) was social problems, and the predictors were motor skills, inattentive symptoms, and hyperactivity/impulsive symptoms. Social problems, inattentive symptoms, and hyperactivity/impulsive symptoms were analyzed as T-scores. The GLMMs were implemented through SPSS’s (Version 22) GENLINMIXED procedure. The GLMM represents a special class of regression model. The GLMM is “generalized” in the

sense that it can handle DVs with markedly non-normal distributions, such as the DVs in this study; the GLMM is “mixed” in the sense that it includes both random and fixed effects. For the teacher GLMM, there were three scale fixed effects (motor skills, inattentive symptoms, hyperactivity/ impulsive symptoms) and three nominal random effects (school, teacher, child). The parent model had the same three fixed effects. Even though the parent ratings were not expected to be strongly affected by the child’s school or teacher, it was decided to include these as random effects in the parent model to enhance its comparability with the teacher model. After controlling for the clustering in the data attributable to the random effects (which would be minimal for the parent model), a three-predictor GLMM would require 55 participants to capture “moderate” relationships (f2 = .15) between each predictor and the DV. Both the parent model (n = 113) and the teacher model (n = 77) satisfied this requirement. A multi-step model testing was used for both parent and teacher modeling. Stage 1 has considered the GLMMs predicting social problems from motor skills, and Stage 2 has controlled the role of the inattentive symptoms and hyperactivity/impulsive symptoms in this relationship. Other statistical procedures included the WilcoxonSigned Ranks Test for comparing parents and teachers in terms of their mean ratings of children’s social problems, inattentive symptoms, and hyperactivity/impulsive symptoms, and a principal components analysis with promax rotation to determine whether the parent- and teacherrated social problem items loaded on distinct factors.

Results Comparing Parent and Teacher Ratings Results suggested differences in the frequency of reported ADHD and social problems between parents and teachers, consistent with previous findings (Antrop et al., 2002; Coates, Taylor, & Sayal, 2014; Fagan & Fantuzzo, 1999). According to parent-report, 25% of children demonstrated “clinically significant” ADHD problems (i.e., T-score above 65), whereas the prevalence of ADHD problems according to teachers was 12%. For inattention, 25% of children demonstrated problems in this area according to parents, and 10% were classified as having attention problems by teachers. According to parents, 30% of children demonstrated problems with hyperactivity/impulsivity compared with 14% for teachers. Similarly, the prevalence of social problems according to parent-report was 26%, whereas teacher-rated social problems were at 11%. In the present sample, eight children (6.2%) demonstrated motor skill difficulties on the MAND (at or below 15th percentile), in line with DSM-V estimates of 5% to 6%.

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

5

Goulardins et al. Table 1.  Descriptive Statistics.

Parent  Inattentive  Hyperactivity-impulsive   Social problems Teacher  Inattentive  Hyperactivity-impulsive   Social problems  NDI-MAND

n

Minimum

113 113 113

40 43 45

77 77 77 129

41 42 45 43

Maximum

M

SD

90 90 90

57.68 59.52 56.16

11.82 13.44 12.47

75 81 90 147

52.94 52.26 52.73 93.13

9.48 10.49 11.35 18.46

Note. NDI = Neuromuscular Developmental Index; MAND = McCarron Assessment of Neuromuscular Development.

Table 2.  Pattern Matrix of Individual Items for the Social Problems.

Parent items   Loses friends   Does not make friends   No friends   Does not get invited   Feels inferior Teacher items   Does not make friends   No friends  Unaccepted   Last to be picked   Poor social skills

1

2 .852 .844 .844 .759 .570

.914 .910 .853 .825 .816

Predictor   Motor skills Inattentive symptoms Hyperactivity/impulsive

Rating of social problems Parent model −.200* .653*** .534***

Teacher model −.300** .459*** .481***

*p < .05. **p < .01. ***p < .001.

common to both questionnaires (e.g., has no friends), they still load on different factors.

Screening for Control Variables

Component  

Table 3.  Pearson Correlations Between Social Problems and Predictors for the Parent (n = 113) and Teacher (n = 77) Models.

         

Wilcoxon-Signed Ranks Test showed no significant difference between parents and teachers in terms of their average ratings of children’s social problems, z(n = 77) = 1.93, p = .054; however, compared with teacher ratings, parent ratings were significantly higher in terms of inattentive symptoms, z(n = 77) = 3.99, p < .001, and hyperactivity/ impulsive symptoms, z(n = 77) = 4.20, p < .001. Table 1 contains the descriptive statistics for the NDI scores and for the parent and teacher reports of inattentive symptoms, hyperactivity-impulsive symptoms, and social problems. There was no significant relationship between parents and teachers in terms of their ratings of children’s social problems, r(n = 77) = .169, p = .143; however, there were significant—but not strong—relationships between parents and teachers in terms of their ratings of children’s inattentive symptoms, r(n = 77) = .536, p < .001, and hyperactivity/ impulsive symptoms, r(n = 77) = .313, p = .006. Table 2 describes the factor analysis of the individual items for the social problems. Teacher and parent ratings of social skills load neatly on different factors. The factor analysis was conducted to show that, even when items are

In order for an extraneous variable to confound the relationships between the social problems and the predictors (motor skills, inattentive, hyperactivity/impulsive), the extraneous variable needs to be significantly correlated with the DV and at least one of the predictors. The potential control variables were child age and gender, and none of these was correlated with the DV, and therefore none needed to be controlled. It is important to note that the lack of relation between age and the study’s primary variables was likely due to the use of standard scores that already correct for age (i.e., are based on each test’s age-matched normative sample).

Testing the GLMMs Table 3 reports the Pearson correlations between social problems and predictors for the parent and teacher models. The models show the same pattern of significant correlations. The results of the GLMM analyses are reported in Table 4 and were divided into two stages of analysis. For both the parent and teacher models, motor skills were a significant predictor of social problems (Stage 1). After controlling for ADHD symptomatology, motor skills remained a significant predictor in the teacher model but not in the parent model. After controlling for motor skills, inattentive (not hyperactive-impulsive) symptoms was a significant predictor of social problems in the parent model, although parent-rated inattentive symptoms fell just short of significance as a predictor of teacher-rated social problems, F(1, 73) = 3.19, p = .078. Hyperactiveimpulsive (not inattentive) symptoms were a significant predictor of social problems in the teacher model (Stage 2); teacher-rated hyperactive-impulsive symptoms were also a significant predictor of parent-rated social problems, F(1, 73) = 12.08, p = .001, which provides some evidence against a mono-informant bias explanation for the withinmodel relationships.

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

6

Journal of Attention Disorders 

Table 4.  Parent (n = 113) and Teacher (n = 77) GLMMs Predicting Social Problems From Motor Skills, Inattentive Symptoms, and Hyperactivity/Impulsive Symptoms. 95% CI Predictor Parent model   Stage 1   Motor skills   Stage 2   Motor skills   Inattentive symptoms   Hyperactivity/impulsive symptoms Teacher model   Stage 1   Motor skills   Stage 2   Motor skills   Inattentive symptoms   Hyperactivity/impulsive symptoms

β

Lower Upper

t

p

−.132

−.247

−.017

2.28

.025*

−.025 .557 .155

−.109 .305 −.047

.059 .809 .357

0.59 4.38 1.52

.559 < .000*** .131

−.185

−.316

−.054

2.81

.006**

−.201 .111 .481

−.343 −.446 .072

−.059 .669 .891

2.814 0.40 2.35

.006** .691 .022*

Note. GLMM = Generalized Linear Mixed Models; CI = confidence interval. *p < .05. **p < .01. ***p < .001.

Discussion The present findings provide further evidence for the important link between motor performance and social competence (Boyer et al., 2014; Cairney et al., 2013; Cummins et al., 2005; Livesey et al., 2011; Rigoli et al., 2012; Skinner & Piek, 2001; Smyth & Anderson, 2000), as motor skills were found to predict social problems for both the parent and teacher models. The results also support the literature regarding an important relationship between ADHD symptoms and social problems (Frederick & Olmi, 1994; Marques et al., 2013; Nijmeijer et al., 2008; Wehmeier et al., 2010). However, the present study adds to the existing research, which has often overlooked the confounding effects of ADHD symptomatology and motor skills in these relationships. The results of this study suggested different relationships when these were taken into account. Furthermore, the study also presents differential findings, depending on whether parents or teachers rated the ADHD and social problems. When teachers were the informant for ADHD symptomatology and social problems, motor skills remained a significant predictor of social problems over and above the ADHD symptomatology. Conversely, motor skills did not significantly predict social problems after controlling for ADHD symptomatology, for the parent model. These results highlight the importance of considering different raters when exploring these relationships as well as also suggesting that possible inconsistencies in the literature may be explained by the particular informant used in the study. To further understand the different findings across the parent

and teacher models, and given the low agreement between parent- versus teacher-reported social problems, the present study also examined whether measurement issues were a plausible explanation for the results. An inspection of the items across the parent versus teacher social problems subscale suggested some differences. For example, the item “last to be picked,” an important negative social outcome associated with motor problems, is included in the teacherrated social problems subscale but not for parents. However, our results suggest that the weak correlation between teacher and parent ratings cannot be simply attributed to the questionnaires having different items because even when items are common to both questionnaires (e.g., has no friends), they still load on different factors. Therefore, it is plausible that the varying results across the parent and teacher models may be explained by context specific factors and differing informant perspectives (Barkley, 1998). Previous research has highlighted that specific social skills and behaviors can be context dependent, which may partly explain the present findings (Murray, Ruble, Willis, & Molloy, 2009). For example, it is plausible that a school environment presents higher motor and social demands for a child and therefore some social behaviors may be more evident at school, such as a lack of interest in, or avoidance of, particular activities that require physical response, difficulties in socializing with peers or the preference for playing with young children, decreased self-esteem and confidence, low frustration tolerance, and a lack of motivation due to the difficulties faced in such an environment (Losse et al., 1991; Skinner & Piek, 2001; Smyth & Anderson, 2000). The results of the present study reinforce this hypothesis as the motor skills remained a significant predictor in the teacher model but not in the parent model. In terms of the relationship between ADHD symptomatology and social problems, the results revealed that once motor skills were taken into account, teacher-rated hyperactive/ impulsive, but not inattentive, symptoms were a significant predictor of social problems. Conversely, for the parent model, inattentive but not hyperactive/impulsive symptoms were a significant predictor of social problems, after controlling for motor skills. These results further highlight the importance of taking differing raters into account when understanding the relationships presented in the literature. During childhood, social interactions predominantly occur in the school environment. It is plausible that the relationship between hyperactive-impulsive symptoms and social problems is more evident in this context. Restless and intrusive behaviors are often inappropriate and may be resistant to correction (Nijmeijer et al., 2008), affecting relationships with teachers and peers. In fact, disruptive classroom behavior has been associated with lowered social status and greater peer rejection (Frederick & Olmi, 1994). Schlack et al. (2014) found that teachers reported increased social performance deficits for ADHD-combined children compared

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

7

Goulardins et al. with controls, but not for ADHD-inattentive children. Conversely, in another study, parents reported an increased social performance deficit for both ADHD-combined and -inattentive subtypes (Maedgen & Carlson, 2000). The findings of the present findings suggest that inattentive and hyperactive/impulsive symptoms may have differential impacts on social functioning depending on the specific context in which these behaviors are observed. In this study, the results also revealed a moderate relationship between parent and teacher ratings of ADHD symptoms, in contrast to previous findings which have shown no significant association between parent and teacher ratings of ADHD symptomatology (Antrop et al., 2002; Coutinho, Mattos, Schmidtz, Fortes, & Borges, 2009; Fagan & Fantuzzo, 1999; Manz, Fantuzzo, & McDermott, 1999). Martin et al. (2002) used multiple informants to examine heritability estimates of ADHD and the impact of observer effects on these estimates in an epidemiological sample of twins. For both teacher- and parent-rated data, ADHD was found to be highly heritable; however, the results revealed only a modest correlation between the two raters. Although it was suggested that the different informants may be observing the effects of different genes, other explanations are also plausible, such as scoring the same phenotype differently due to particular rater biases. Alternatively, Martin et al. (2002) note that the children may in fact be behaving differently at home versus school, and therefore different behaviors are being observed. Barkley (1998) has also suggested that ADHD symptomatology may fluctuate across different situations and contexts. In the present study, parent ratings of ADHD symptomatology were higher than those reported by teachers, which has been frequently reported in clinically referred samples (Antrop et al., 2002). The strength of the present study is the use of a communitybased sample as clinical studies tend to oversample those individuals who are relatively more impaired. The use of both teacher- and parent-informants is another important strength of this study. There is extensive evidence demonstrating that parents and teachers are valid informants in the assessment of childhood neurodevelopmental problems but that they provide different information (Antrop et al., 2002; Crippa et al., 2014; Fliers et al., 2008; Murray et al., 2009). The present study presents some limitations that should be considered in future research. For example, this study did not differentiate gross from fine motor skills. It is plausible that certain motor aspects may affect social outcomes differentially. It is important to note that the cross-sectional nature of this study also presents a limitation. Furthermore, there may be other confounding factors, which have not been considered in the present study. For example, verbal ability and socio-economic status may be important factors to include in future studies, given their potential predictive ability in the social domain. Also, although no children in this study had a previously identified diagnosis of ASD, there is the possibility that some of the children with motor

problems may have undiagnosed ASD or “autistic traits” (i.e., some symptoms without fulfilling a diagnosis of ASD) and may have social difficulties as a part of this autism-like condition. Future research should also be directed at investigating effects of motor skills, inattention, hyperactivity, and impulsivity on social competence over various developmental ages, using longitudinal methodology. For example, previous studies have reported a general decline in hyperactivity-impulsivity symptoms with age and a general increase in inattentive symptoms (Larsson, Dilshad, Lichtenstein, & Barker, 2011). The importance of motor competence for the social functioning may also fluctuate over time, as the demands of the environment also change.

Conclusion Ultimately, the results presented in this study have important implications for the assessment and intervention of ADHD and motor problems. For example, it is important to consider the impact of motor difficulties on a child’s social functioning during the assessment stage. The results also highlight the need to take possible ADHD symptomatology into account given the strong links between ADHD, motor difficulties, and the social domain. This will contribute to an improved understanding of the psychosocial implications of these childhood difficulties and will assist in guiding intervention and preventive efforts. The findings also highlight the low to moderate interinformant agreement regarding child behavior and the importance of taking multiple informants into account in the assessment of these difficulties. When examining the relationship between motor skills, attention, hyperactivity and impulsivity, and social problems, it is important to consider the interaction between symptoms and environmental contexts as this may also point to appropriate intervention strategies. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Juliana B. Goulardins has received grant/research support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES; Brazilian Federal Agency and Evaluation of Graduate Education), Brazil: Grant 5569-13-3.

References Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213-232.

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

8

Journal of Attention Disorders 

Alonso Bde, C., Hidalgo Tobon, S., Dies Suarez, P., Garcia Flores, J., de Celis Carrillo, B., & Barragan Perez, E. (2014). A multimethodological MR resting state network analysis to assess the changes in brain physiology of children with ADHD. PLoS ONE, 9(6), e99119. doi:10.1371/journal.pone.0099119 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Antrop, I., Roeyers, H., Oosterlaan, J., & Oost, P. V. (2002). Agreement between parent and teacher ratings of disruptive behavior disorders in children with clinically diagnosed ADHD. Journal of Psychopathology and Behavioral Assessment, 24, 67-73. Ayaz, A. B., Ayaz, M., Yazgan, Y., & Akin, E. (2013). The relationship between motor coordination and social behavior problems in adolescents with attention-deficit/hyperactivity disorder. Psikofarmakoloji Bulteni, 23(1), 33-41. doi:10.5455/ bcp.20121130091058 Bagwell, C. L., Newcomb, A. F., & Bukowski, W. M. (1998). Preadolescent friendship and peer rejection as predictors of adult adjustment. Child Development, 69, 140-153. Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY: Guilford Press. Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child Development, 64, 139-151. Boyer, B. E., Geurts, H. M., & Van der Oord, S. (2014). Planning skills of adolescents with ADHD. Journal of Attention Disorders. Advance online publication. doi:10.1177/1087054714538658 Brantner, S., Piek, J. P., & Smith, L. M. (2009). Evaluation of the validity of the MAND in assessing motor impairment in young children. Rehabilitation Psychology, 54, 413-421. doi:10.1037/a0017315 Cairney, J., Hay, J. A., Faught, B. E., Wade, T. J., Corna, L., & Flouris, A. (2005). Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. Journal of Pediatrics, 147, 515-520. doi:10.1016/j.jpeds.2005.05.013 Cairney, J., Rigoli, D., & Piek, J. (2013). Developmental coordination disorder and internalizing problems in children: The environmental stress hypothesis elaborated. Developmental Review, 33, 224-238. Campbell, W. N., Missiuna, C., & Vaillancourt, T. (2012). Peer victimization and depression in children with and without motor coordination difficulties. Psychology in the Schools, 49, 328-341. doi:10.1002/pits.21600 Coates, J., Taylor, J. A., & Sayal, K. (2014). Parenting interventions for ADHD: A systematic literature review and meta-analysis. Journal of Attention Disorders. Advance online publication. doi:10.1177/1087054714535952 Conners, C. K. (1997). Conners’ Rating Scales–Revised: Long Form. North Tonawanda, NY: Multi-Heath Systems. Coutinho, G., Mattos, P., Schmitz, M., Fortes, D., & Borges, M. (2009). Agreement rates between parents’ and teachers’ reports

on ADHD symptomatology: Findings from a Brazilian clinical sample. Revista de Psiquiatria Clínica, 36(3), 101-104. Crippa, A., Marzocchi, G. M., Piroddi, C., Besana, D., Giribone, S., Vio, C., . . .Sora, M. L. (2014). An integrated model of executive functioning is helpful for understanding ADHD and associated disorders. Journal of Attention Disorders. Advance online publication. doi:10.1177/1087054714542000 Cummins, A., Piek, J. P., & Dyck, M. J. (2005). Motor coordination, empathy, and social behaviour in school-aged children. Developmental Medicine & Child Neurology, 47, 437-442. Dyck, M., Piek, J., Kane, R., & Patrick, J. (2009). How uniform is the structure of ability across childhood? European Journal of Developmental Psychology, 6, 432-454. Fagan, J., & Fantuzzo, J. W. (1999). Multirater congruence on the social skills rating system: Mother, father, and teacher assessments of urban head start children’s social competencies. Early Childhood Research Quarterly, 14, 229-242. doi:10.1016/S0885-2006(99)00010-1 Fliers, E., Rommelse, N., Vermeulen, S. H., Altink, M., Buschgens, C. J., Faraone, S. V., . . .Buitelaar, J. K. (2008). Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: Effects of age and gender. Journal of Neural Transmission, 115, 211-220. doi:10.1007/ s00702-007-0827-0 Frederick, B. P., & Olmi, D. J. (1994). Children with attention deficit/hyperactivity disorder: A review of the literature on social skills deficits. Psychology in the Schools, 31, 288-296. Gustafsson, P., Kerekes, N., Anckarsater, H., Lichtenstein, P., Gillberg, C., & Rastam, M. (2014). Motor function and perception in children with neuropsychiatric and conduct problems: Results from a population based twin study. Journal of Neurodevelopmental Disorders, 6, Article 11. doi:10.1186/1866-1955-6-11 Hartman, C. A., Rhee, S. H., Willcutt, E. G., & Pennington, B. F. (2007). Modeling rater disagreement for ADHD: Are parents or teachers biased? Journal of Abnormal Child Psychology, 35, 536-542. doi:10.1007/s10802-007-9110-y Hoza, B., Gerdes, A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., . . .Wigal, T. (2005). Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 34, 74-86. doi:10.1207/ s15374424jccp3401_7 Larsson, H., Dilshad, R., Lichtenstein, P., & Barker, E. D. (2011). Developmental trajectories of DSM-IV symptoms of attentiondeficit/hyperactivity disorder: Genetic effects, family risk and associated psychopathology. Journal of Child Psychology and Psychiatry, 52, 954-963. doi:10.1111/ j.1469-7610.2011.02379.x Lingam, R., Jongmans, M. J., Ellis, M., Hunt, L. P., Golding, J., & Emond, A. (2012). Mental health difficulties in children with developmental coordination disorder. Pediatrics, 129, e882-e891. doi:10.1542/peds.2011-1556 Livesey, D., Lum Mow, M., Toshack, T., & Zheng, Y. (2011). The relationship between motor performance and peer relations in 9- to 12-year-old children. Child: Care, Health and Development, 37, 581-588. doi:10.1111/ j.1365-2214.2010.01183.x

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

9

Goulardins et al. Losse, A., Henderson, S. E., Elliman, D., Hall, D., Knight, E., & Jongmans, M. (1991). Clumsiness in children—Do they grow out of it? A 10-year follow-up study. Developmental Medicine & Child Neurology, 33, 55-68. Maedgen, J. W., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29(1), 30-42. doi:10.1207/S15374424jccp2901_4 Manz, P. H., Fantuzzo, J. W., & McDermott, P. A. (1999). The parent version of the preschool Social Skills Rating Scale: An analysis of its use with low-income, ethnic minority children. School Psychology Review, 28, 493-504. Marques, J. C., Oliveira, J. A., Goulardins, J. B., Nascimento, R. O., Lima, A. M., & Casella, E. B. (2013). Comparison of child self-reports and parent proxy-reports on quality of life of children with attention deficit hyperactivity disorder. Health Quality of Life Outcomes, 11, Article 186. doi:10.1186/ 1477-7525-11-186 Martin, N., Scourfield, J., & McGuffin, P. (2002). Observer effects and heritability of childhood attention-deficit hyperactivity disorder symptoms. British Journal of Psychiatry, 180, 260-265. McHale, S. M., Crouter, A. C., & Tucker, C. J. (2001). Free-time activities in middle childhood: Links with adjustment in early adolescence. Child Development, 72, 1764-1778. Murray, D. S., Ruble, L. A., Willis, H., & Molloy, C. A. (2009). Parent and teacher report of social skills in children with autism spectrum disorders. Language Speech and Hearing Services in Schools, 40, 109-115. doi:10.1044/0161-1461(2008/07-0089) Nijmeijer, J. S., Minderaa, R. B., Buitelaar, J. K., Mulligan, A., Hartman, C. A., & Hoekstra, P. J. (2008). Attentiondeficit/hyperactivity disorder and social dysfunctioning. Clinical Psychology Review, 28, 692-708. doi:10.1016/ j.cpr.2007.10.003 Pedersen, S., Vitaro, F., Barker, E. D., & Borge, A. I. (2007). The timing of middle-childhood peer rejection and friendship: Linking early behavior to early-adolescent adjustment. Child Development, 78, 1037-1051. doi:10.1111/j.14678624.2007.01051.x Pettersson, E., Sjolander, A., Almqvist, C., Anckarsater, H., D’Onofrio, B. M., Lichtenstein, P., & Larsson, H. (2015). Birth weight as an independent predictor of ADHD symptoms: A within-twin pair analysis. Journal of Child Psychology and Psychiatry, 56, 453-459. doi:10.1111/jcpp.12299 Piek, J. P., Bradbury, G. S., & Elsley, S. C. (2008). Motor coordination and social–emotional behaviour in preschool-aged children. International Journal of Disability, Development and Education, 55, 143-151. doi:10.1080/10349120802033592 Pitcher, T. M., Piek, J. P., & Hay, D. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine & Child Neurology, 45, 525-535. Poulsen, A. A., Ziviani, J. M., Cuskelly, M., & Smith, R. (2007). Boys with developmental coordination disorder: Loneliness and team sports participation. American Journal of Occupational Therapy, 61, 451-462. Rigoli, D., Piek, J. P., & Kane, R. (2012). Motor coordination and psychosocial correlates in a normative adolescent sample. Pediatrics, 129, e892-e900. doi:10.1542/peds.2011-1237

Schlack, R., Mauz, E., Hebebrand, J., & Holling, H. (2014). Has the prevalence of parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) in Germany increased between 2003-2006 and 2009-2012? Results of the KiGGS-study: First follow-up (KiGGS Wave 1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 57, 820-829. doi:10.1007/s00103-014-1983-7 Skinner, R. A., & Piek, J. P. (2001). Psychosocial implications of poor motor coordination in children and adolescents. Human Movement Science, 20, 73-94. Smyth, M. M., & Anderson, H. I. (2000). Coping with clumsiness in the school playground: Social and physical play in children with coordination impairments. British Journal of Developmental Psychology, 18, 389-413. Tarver, J., Daley, D., & Sayal, K. (2015). Beyond symptom control for attention-deficit hyperactivity disorder (ADHD): What can parents do to improve outcomes? Child: Care, Health and Development, 41, 1-14. doi:10.1111/cch.12159 Tervo, R. C., Azuma, S., Fogas, B., & Fiechtner, H. (2002). Children with ADHD and motor dysfunction compared with children with ADHD only. Developmental Medicine & Child Neurology, 44, 383-390. Tseng, M. H., Henderson, A., Chow, S. M., & Yao, G. (2004). Relationship between motor proficiency, attention, impulse, and activity in children with ADHD. Developmental Medicine & Child Neurology, 46, 381-388. Vannattaa, K., Gartsteinb, M. A., Zellerc, M., & Nolld, R. B. (2009). Peer acceptance and social behavior during childhood and adolescence: How important are appearance, athleticism, and academic competence? International Journal of Behavioral Development, 33, 303-311. doi:10.1177/0165025408101275 Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46, 209-217. doi:10.1016/ j.jadohealth.2009.09.009 Wilson, A., Piek, J., & Kane, R. (2013). The mediating role of social skills in the relationship between motor ability and internalizing symptoms in pre-primary children. Infant and Child Development, 22, 151-164. Wolraich, M. L., Lambert, E. W., Bickman, L., Simmons, T., Doffing, M. A., & Worley, K. A. (2004). Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder. Journal of Developmental and Behavioral Pediatrics, 25, 41-47.

Author Biographies Juliana B. Goulardins, MS, is a physiotherapist and a PhD student in the School of Physical Education and Sports, University of São Paulo, and a researcher member of the Study Group of Attention to Child Development in Brazil. She completed her masters in the Child Institute Faculty of Medicine of the same university. Daniela Rigoli, PhD, works with the School of Psychology and Speech Patholgy as the Project Coordinator for the Infant Motor Development Project and the Development of Rapid On-line Motor Control in Children.

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

10

Journal of Attention Disorders 

Pek Ru Loh, PhD, is a registered psychologist with the Australian Health Practitioner Regulation Agency (AHPRA) and is a member of the Singapore Psychological Society. Robert Kane, PhD, is a Senior Lecturer at Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University. His area of expertise is research design and data analysis in applied behavioral research. Melissa Licari, PhD, Assistant Professor and researcher in the area of motor control and development within the School of Sport Science, Exercise & Health at the University of Western Australia. Beth Hands, PhD. Before accepting the position of Director she was Associate Dean, Health and Physical Education in the School

of Health Sciences. She was the Project Director of the WA Child and Adolescent Physical Activity and Nutrition Survey 2003 (WA CAPANS) conducted by the University of Notre Dame Australia for the Premier’s Physical Activity taskforce and is an Honorary Research Fellow with the Telethon ICHR. Jorge A. Oliveira, PhD, is a Professor and researcher in the area of motor development and motor behavior within the School of Education and Sports at the University of Sao Paulo. Jan Piek, PhD, is Emeritus Professor at the School of Psychology and Speech Pathology at Curtin University, Perth, Western Australia. Over the last 20 years, Dr. Piek and her team have researched extensively in the area of motor development and disability.

Downloaded from jad.sagepub.com at WESTERN OREGON UNIVERSITY on June 2, 2015

The Relationship Between Motor Skills, Social Problems, and ADHD Symptomatology: Does It Vary According to Parent and Teacher Report?

This study investigated the relationship between motor performance; attentional, hyperactive, and impulsive symptoms; and social problems. Correlation...
270KB Sizes 4 Downloads 7 Views